From the Department of Anesthesiology and Critical Care Medicine, University Montpellier I, and Lapeyronie University Hospital, Montpellier, France.
Anesthesiology. 2014 Jun;120(6):1362-9. doi: 10.1097/ALN.0000000000000171.
The authors investigated the efficacy of bilateral suprazygomatic maxillary nerve block (SMB) for postoperative pain relief in infants undergoing cleft palate repair.
In this prospective, double-blind, single-site, randomized, and parallel-arm controlled trial, 60 children were assigned to undergo bilateral SMB with general anesthesia with either 0.15 ml/kg of 0.2% ropivacaine (Ropi group) or 0.15 ml/kg of isotonic saline (Saline group) on each side. The primary endpoint was total postoperative morphine consumption at 48 h. Pain scores and respiratory- and SMB-related complications were noted.
The overall dose of intravenous morphine after 48 h (mean [95% CI]) was lower in the Ropi group compared with that in the Saline group (104.3 [68.9 to 139.6] vs. 205.2 [130.7 to 279.7] μg/kg; P = 0.033). Continuous morphine infusion was less frequent in the Ropi group compared with that in the Saline group (1 patient [3.6%] vs. 9 patients [31%]; P = 0.006). Three patients in the Saline group had an episode of oxygen desaturation requiring oxygen therapy. There were no technical failures or immediate complications of the SMB. Intraoperative hemodynamic parameters, doses of sufentanil, pain scores, and postoperative hydroxyzine requirements were not different between the two groups.
Bilateral SMB is an easy regional anesthesia technique that reduces total morphine consumption at 48 h after cleft palate repair in children and the use of continuous infusion of morphine and may decrease postoperative respiratory complications.
作者研究了双侧颧上颌神经阻滞（SMB）在接受腭裂修复术的婴儿中的术后镇痛效果。
在这项前瞻性、双盲、单中心、随机、平行臂对照试验中，将 60 名儿童随机分为两组，在全身麻醉下于每侧接受 0.15ml/kg 的 0.2%罗哌卡因（罗哌组）或 0.15ml/kg 的等渗盐水（盐水组）的双侧 SMB。主要终点是术后 48 小时内总吗啡消耗量。记录疼痛评分和与呼吸及 SMB 相关的并发症。
与盐水组相比，罗哌组术后 48 小时内静脉注射吗啡的总剂量（平均[95%CI]）较低（104.3[68.9 至 139.6] vs. 205.2[130.7 至 279.7]μg/kg；P=0.033）。与盐水组相比，罗哌组接受持续吗啡输注的患者较少（1 例[3.6%] vs. 9 例[31%]；P=0.006）。盐水组有 3 例患者出现需要氧疗的血氧饱和度下降。SMB 无技术失败或即刻并发症。两组术中血流动力学参数、舒芬太尼剂量、疼痛评分和术后氢可酮需求无差异。
双侧 SMB 是一种简单的区域麻醉技术，可减少腭裂修复术后 48 小时内儿童吗啡的总消耗量，减少连续输注吗啡的使用，并可能降低术后呼吸并发症的发生率。
